Are Restrictions Post Discectomy Necessary?

Are Restrictions Post Discectomy Necessary?

Are Restrictions Post Discectomy Necessary?

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After lumbar disk surgery,  there is a common misconception that all future activities must be restricted.  More and more evidence indicates that the vast majority of post lumbar discectomy patients can and should be able to return back to all activities.  

Medical Science is a constant evolution of thoughts and processes.  Thirty years ago,  patients were admitted to hospitals for procedures such as carpal tunnel surgery.  They stayed admitted until the wound was healed.   Now,  select patients are getting knees replaced on an outpatient basis.

Likewise,  there is a change in post surgical management,  and post surgical activity recommendations.

Traditionally,  post lumbar discectomy patients were placed under protective restrictions.  Some recommended bedrest.  Others restricted any future lifting of any significant weight.  Traditional post lumbar discectomy therapy regimens varied from no therapy,  to delaying therapy for the first six weeks.

Meta analysis of various papers regarding post lumbar discectomy activities restrictions,  and post lumbar discectomy rehabilitation has been essentially inconclusive about the necessity of either process.

Many physicians,  including myself, encourage post lumbar discectomy patients to return back to all activities within 4-6 weeks.  Also,  from the stand point of costs and the need for formal therapy,  most analysis conclude there is no difference in outcomes for post lumbar discectomy patients, with or without formal physical therapy.

I am not suggesting Physical Therapy is not helpful for spine patients.  But in terms of improving the patient after lumbar discectomy surgery,  there is no identifiable advantage.  In theory, the reason the patient had surgery,  the herniated disk ,  has now been removed.  Therapy is no longer necessary for the nerve dysfunction.

In terms of activities restrictions,  once the offending disk herniation has been removed,  the irritated nerve now has the ability to recover.  After recovery,  restrictions are not needed.

Some patients do have recurrent disk herniations and recurrent pains.  Some will blame the surgery for the recurrence of symptoms.  But,  the truth is,  the recurrent disk herniation is not secondary to the surgery,  but rather because the original reason for the first disk herniation is still present.  The tear in the annulus,  and the dessication of  the disk is a continuing process.  Reherniation will occur regardless of the surgery in most situation  ( be aware,  there is a study indication some types of discectomy surgery is associated with increased rates of reherniation,  but most will agree,  the root cause of disk herniations is still secondary to the original cause of the herniation,  rather than a specific technique).

If you are to have Lumbar Discectomy Surgery,  it is highly likely that you will be able to return back to ALL activities.  Ultimately,  however,  you need to speak to your Surgeon to determine if you should get back to everything.  Sometimes,  your Surgeon may have another concern that will necessitate activities caution.

 

REFERENCES:

 1. Spine (Phila Pa 1976). 1999 Nov 15;24(22):2346-51.

Activity restrictions after posterior lumbar discectomy. A prospective study of outcomes in 152 cases with no postoperative restrictions.
Carragee EJ1, Han MY, Yang B, Kim DH, Kraemer H, Billys J.

 

 2. Spine (Phila Pa 1976). 2008 Jan 1;33(1):33-8. doi: 10.1097/BRS.0b013e31815e3a42.

The outcomes of lumbar microdiscectomy in a young, active population: correlation by herniation type and level.

Dewing CB1, Provencher MT, Riffenburgh RH, Kerr S, Manos RE.

 

Am J Sports Med. 2011 Mar;39(3):632-6. doi: 10.1177/0363546510388901. Epub 2011 Jan 10.

Return-to-play rates in National Football League linemen after treatment for lumbar disk herniation.
Weistroffer JK1, Hsu WK.

 

3. Cochrane Database Syst Rev. 2014 Mar 14;3:CD003007. doi: 10.1002/14651858.CD003007.pub3.

Rehabilitation after lumbar disc surgery.

Oosterhuis T1, Costa LO, Maher CG, de Vet HC, van Tulder MW, Ostelo RW.

Spine (Phila Pa 1976). 2003 Feb 1;28(3):209-18.

Rehabilitation following first-time lumbar disc surgery: a systematic review within the framework of the cochrane collaboration.

Ostelo RW1, de Vet HC, Waddell G, Kerckhoffs MR, Leffers P, van Tulder M.

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Author and Contributor to www.Spine-Health.com – July, 2015

www.Spine-Health.com/author/john-h-shim-md-facs

Chief of Surgery, Mease Countryside and Mease Dunedin Hospitals, Safety Harbor and Dunedin, Florida. 2014-2016.

Orthopaedic Section Chief Mease Countryside Hospital; Safety Harbor, Florida Mease Dunedin Hospital; Dunedin, Florida.2008-2013

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Co-Director of Mease Neuro-Ortho Spine Center Mease Dunedin Hospital; Dunedin, Florida.

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2014 Spine Specialists to know list – September 2014

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The Best Orthopedics in Tampa

The information provided on this website does not provide or should be considered medical advice. It is not a substitute for diagnosis or treatment of any condition. The information provided is for informational purposes only. You should not rely solely on the information provided on this website in making a decision to pursue a specific treatment or advice. You should consult directly with a professional healthcare provider.

As a condition of using the information on this website, ShimSpine and its physicians are not responsible for any advice, diagnosis, treatment or outcome you may obtain.

ShimSpine.com is completely self-funded. No outside funds are accepted or used. This website does not utilize paid advertising as a source of revenue.
Outpatient Spine Surgery Considerations. www.Spine-Health.com. January 2016.

What is Spinal Stenosis? www.Spine-Health.com. October 2015.

Surgeon insights on the Changing Landscape of Orthopedic Care. OrthopedicToday. June 2014

Chapter 33: Interspinous Spacers. Shim JH, Mazza JS, Kim DH Published in Minimally Invasive Percutaneous Spinal Techniques. Elsevier Health Sciences, Philadelphia, Pennsylvania. (Published 2011)

Chapter 35: Minimally Invasive Percutaneous Lumbar Fusion Technique.Shim JH, Mazza JS, Kim DH Published in Minimally Invasive Percutaneous Spinal Techniques. Elsevier Health Sciences, Philadelphia, Pennsylvania. (Published 2011)

March 2010 Minimally Invasive Transforaminal Lumbar Interbody Fusion American Academy of Orthopaedic Surgeons Annual Meeting New Orleans, Louisiana February 2010

February 2010 A Review of Dynamic Stabilization in the Lumbar Spine Selby Spine Symposium; Park City, Utah

November 2009 Lumbar Spinal Stenosis Community Based Lecture; Tampa, Florida

September 2009 Instructor/Proctor Minimally Invasive Lumbar Cadaver Lab; Tampa, Florida

February 2009 New Spinal Technology: Cervical Disc Replacement and Interspinous Spacers. Selby Spine Symposium; Park City, Utah

February 2008 The Degenerative Spine: The Role of Dynamic Lumbar Stablization and Interspinous Spacers Selby Spine Symposium; Park City, Utah

October 2008 Emerging Technology and Techniques in Spinal Surgery Orthopaedics in the 21st Century Symposium; Morton Plant Mease Healthcare; Largo, Florida

September 2007 Emerging Technology in Spinal Surgery Orthopaedics in the 21st Century Symposium; Morton Plant Mease Healthcare; Largo, Florida

October 2006 Emerging Technology and Techniques in Spinal Surgery Orthopaedics in the 21st Century Symposium; Morton Plant Mease Healthcare; Largo, Florida

May 2005 The Role of Kyphoplasty in the Treatment of Vertebral Compression Fractures Mease Neurosciences Symposium; Clearwater, Florida
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